AUTHOR=Tavazzi Guido , Dammassa Valentino , Colombo Costanza Natalia Julia , Arbustini Eloisa , Castelein Thomas , Balik Martin , Vandenbriele Christophe 

TITLE=Mechanical circulatory support in ventricular arrhythmias

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.987008

DOI=10.3389/fcvm.2022.987008

ISSN=2297-055X

ABSTRACT=In atrial and ventricular tachyarrhythmias, reduced time for ventricular filling and loss of atrial contribution lead to significant reduction in cardiac output resulting in cardiogenic shock. This may also occur during catheter ablation in 11% of overall procedures and it is associated with increased mortality.
Management of cardiogenic shock and (supra)ventricular arrhythmias is particularly challenging. Inotropic support may worsen tachyarrhythmias or accelerate heart rate, antiarrhythmic drugs often come with negative inotropic effects and electrical reconversions may risk worsening circulatory failure or even cardiac arrest. Drop of native cardiac output during arrhythmic storm can be partly covered by insertion of percutaneous mechanical circulatory support (MCS) devices guaranteeing end-organ perfusion. That provides physicians a time-window of stability to investigate the underlying cause of arrhythmia and allow proper therapeutic interventions (e.g., percutaneous coronary intervention and catheter ablation). Temporary MCS can be used in case of overt haemodynamic decompensation or as ‘pre-emptive strategy’ to avoid circulatory instability during interventional cardiology procedures in high-risk patients.
Despite the increasing use of MCS in cardiogenic shock and during catheter ablation procedures, the level of recommendation is still rather low considering the lack of large observational studies and randomized clinical trials. Therefore, also the evidence on timing and kind of MCS devices has been scarcely investigated.
In the current review we discuss the available evidence in literature and gaps in knowledge on the use of MCS devices in the setting of ventricular arrhythmias and arrhythmic storm, including specific focus on pathophysiology and related therapies.